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A key to the success of the Quantum Health Care Coordinators Program is receiving notices of healthcare services that you are seeking. Through such notice, the Care Coordinators can better help you through healthcare services, maximize your benefits under your employer's plan, and assure that your physician is aware of all healthcare events.

What is pre-certification?
Your health plan requires that certain medical services be verified for medical necessity. This verification process is called “pre-certification” and the services needing this are listed on your ID card. Your physician should provide Quantum Health with the needed information. Once this has been received, both you and your physician will receive a “determination” letter on the requested service. If you haven't received a letter from Coordinated Health/Care prior to an elective procedure, please call a Care Coordinator.

How do pre-certifications help the healthcare process?
Your physicians use the pre-certification process as a means of coordinating your care. These notifications enable the physicians to transfer information, keep care in-network to maximize your benefits, and make sure you get the full range of services you need without leaving you on your own. These notifications also serve to ensure in advance that treatment is a covered service under the Plan so there are no surprises for the patient (i.e., learning after the fact that a procedure is not covered by the Plan).